J Lin’s Ruptured Patella Tendon

Watching Jeremy Lin’s recent ruptured patella tendon injury brought back memories of when I tore my right ACL.

Up until my injury, I always thought torn ACLs happen through someone running into you at full speed or getting hit in the legs directly. Little did I know a majority of ACL ruptures are non-contact which makes it even more frustrating. You can be strong, flexible, and self-aware but if you just happen to land at the wrong angle, everything can go haywire.

The Slow Realization

The most devastating part of this video is the confusion J Lin has as he’s feeling his knee. A few seconds when you don’t realize what’s wrong, but just know something is definitely not right.

Granted I didn’t fall to the floor bawling my eyes out but I remember feeling that this is something I’ve never experienced before. It was beyond just sucking it up and playing through the rest of the game. It may require surgery.

Now more than 2 years out from surgery, I’m back to playing full speed and not limited to a certain amount of minutes, but I am still mentally aware of not driving into the lane or trying to battle down low since I know that’s where your body can start to contort and twist in ways you have no control over.

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Having A Functional Knee

Over the last 2 months or so, I haven’t been playing basketball but rather going back to my original physio after my knee swelled up from playing basketball over the summer. After getting another MRI, it turns out I have a thickened plica and some minor cartilage damage, but nothing serious. To top it off, my physio said I have symptoms of Patellofemoral Pain Syndrome which has to do with the joint not tracking correctly.

My focus over the last few months have been strength, since my right quad and VMO are still noticeably smaller than my left non-operative leg. The gains have been slow, and no matter how hard I push or lift, it seems like I’m not making any progress, but I keep on telling myself that each rep, each set, and each repetitive task adds up to a stable and strong knee.

Building Muscle Vs. Function

But what’s the point of getting my right leg to the same exact size as my left? I’ve been thinking about this more and more from a functional perspective, and my physio has helped me realize the mental dilemma I’m putting myself in every time I notice the difference in size between my two legs. Long story short, I used to think that having the exact same power and strength on my operative leg is the goal of coming back to basketball, but I realized that I just need to have a functional leg.

Having super huge quads is great if I’m trying to squat 2X my body weight, but doesn’t necessarily help on the court. There are certain ranges of motion that also make my knee feel uncomfortable like a deep squat or a reverse lunge on my operated leg, but these are all rare positions that I would find myself in an actual 5-on-5 game. I used to think that I cannot feel any pain or discomfort in these specific positions but I’ve relaxed this constraint to focus on what really matters: having a functional knee for basketball.

Having said that, I returned to play about 4 weeks ago playing 20-30 minutes tops per session going about 50-75% effort level. No considerable swelling or discomfort after I play which is awesome! But a few days ago I played two nights in a row and for a longer period and now my knee is a bit swollen on the posterior side. It’s definitely not as bad as the time after I played over the summer, but I’m starting to see the limits of my playing time and functionality

Dilemma Of Not Challenging Your Knee

The biggest challenge I’m facing is knowing when to ease up on the gas and stop playing vs. putting my knee through the stresses and change of motion scenarios to stretch the functionality of my knee. This is a new dilemma I’ve never had to face because in the past, I just played until I was tired from an endurance standpoint, or whenever it was convenient to stop playing. Now, if I play too long I get the swelling which is bad, but if I don’t play enough then I’m not putting sufficient stress on my knee to ensure it can handle a heavier load in the future.

The tough truth is that as we get older, our knee joints and especially the meniscus and cartilage wear down, it’s just a matter of time. I wonder if the discomfort I feel after I play would’ve happened regardless if I had the surgery or not. It sucks to come to this conclusion, but thinking that I can put my knee through the original motions and load I could before is simply insane. The bigger question I’m asking myself now is am I ready to make that lifestyle change to less basketball, and transition to a more “gentle” training regimen like swimming or biking?

I don’t have the answer, and I’m not willing to give up entirely on basketball just yet. Before my injury, I was comfortable going all out on the court and that was my attitude ever since I picked up a basketball in 4th grade. Now more than 20 years later, it’s time to take a step back and look at what really counts.

The goal should be having a healthy knee for life instead of for the short-term highs of playing basketball and risking further damage.

But boy oh boy, the pure joy I felt the day my physio told me to go back to playing for 20 minutes or so. I laced up and pretended like nothing had changed, and was actually making an impact on the court with layups and fast-breaks. Saving that story for the next post.

Guest Post From Dr. Curtis About Chronic Injuries

I posted on IG a picture of some dood touching my knee a few weeks ago:

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I’ve been working with my mans Curtis to help with scar tissue removal from my knee capsule the last few weeks in addition to doing physical therapy. It’s painful, but I definitely get a ton of flexion back right after the session. The below post is a guest post written by Curtis. I don’t get any kickbacks or anything from this, just helping another brother out on the hustle. Read more:

The Secret Problem to Your Chronic, Nagging Injuries

If there was a really simple, easily solvable problem holding you back when it comes to your achey back and the tension in your neck, would you want to know what it is? What if this same problem was also the reason why you’ve plateaued on your fitness gains? And … the SAME issue was also the precursor to osteoarthritis, disc herniations, cartilage tears, and generalized stiffness associated with aging?

What would you do with that information?

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Before I go there, let me introduce myself.

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My name is Dr. Curtis McClelland and I’m the new biomechanical guy doing structured personal fitness.

I’m the licensed chiropractor who doesn’t adjust joints.

I have nothing against traditional chiropractic, it’s just not what I do. And if you love your chiropractor, keep going to him or her! What I do isn’t physical therapy either. But if that’s working for you, great! And no, I’m not a massage therapist either.

I remove the most common pathology in the musculoskeletal system. It’s also the least talked about and most easily get rid-of-able issue out there. This makes it a secret problem, because you’ve probably never heard of it before.

What is it?

Muscle Adhesion

It’s the glue that your body lays down when you overuse tissue without enough time to recover. Some call it “excess fascia.”

Are you tight and you never understood why? It’s probably adhesion. Are you weak and you can’t figure out why all of the lifting you’ve been doing isn’t paying off? It’s probably adhesion.

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Adhesion literally glues down your muscles, preventing its ability to work.

The great thing about having adhesion is that it can be fixed. Most of our patients see objective changes in 4-5 visits, with significant resolution in 10-15 visits.

If you have pain and you don’t have adhesion, then you have structural problems that cannot be fixed. Even surgery can only minimize the magnitude of one of these problems and can’t completely get rid of it.

Curious yet?

I’d like to invite you to explore your body to see what path you’re setting yourself up on?

The one of living an able, functional, pain-free life into old age? Or the one with pain now that you just can’t figure out that’s only going to get worse in ten years, stopping you from doing the things you love?

  1. TAKE 20 MINUTES TO TEST YOURSELF: Go to the Testing section of the Barefoot Rehab website and test yourself.
  2. SAVE THOUSANDS OF DOLLARS + HOURS BY READING OUR FREE GIFT TO YOU: Take 15 minutes to read The 7 Biggest Mistakes People Make When Choosing a Pain Doctor.
  3. TALK WITH ME ABOUT YOUR PAIN: If you’ve only had your pain for a few days or weeks, the research says “80% of the time, it’ll get better no matter what you do”. Wait it out. If you’ve had your pain for more than a month and if you’ve seen multiple providers about your pain, I invite you to have a conversation with me about your pain. Call 929-251-3830 and I’ll discuss your issue with you, free of Charge.
  4. READY TO TAKE YOUR BODY SERIOUSLY? Because I’m starting off with structured personal fitnes, I’d like to offer to the first 10 people who contact me with a $45 exam (normally $145 – that’s $100 discount!) for you to learn just what’s been going on over the years with you. If you aren’t quite sure what we are talking about, we invite you to read the many testimonials we have from our New Jersey Practice

If you’re not sure about me, adhesion, or your injury, that’s OK. Please be gentle with yourself when it comes to doing your workouts though. The highest risk of permanent damage comes when you’ve been given the wrong diagnosis, the wrong advice, and you keep doing what you’re doing. Treat your body with the respect it deserves. This secret problem can wreak havoc, especially when you’ve never had it acknowledged before.

Feel free to come say hello to me on Tuesdays + Thursdays from 9-7 PM. Even if it’s just to say hi. Please email scheduling@barefootrehab.com or call 929-251-3830.

Back On The Court & Setback

A couple weeks ago, I thought I was getting close to a near full recovery from my ACL surgery. I was doing agility and jumping exercises, cutting, and had pretty good numbers on the Biodex machine (shows strength deficiency on injured leg relative to non-injured leg). With all these positive signals, my physio suggested I get back to playing some very light 5-on-5 basketball. It was Thursday morning, and I told myself Saturday is going to be the day I get back on the court.

I took the train out to NYU Brooklyn Athletic Facility at the MetroTech campus. I’ve only been to this facility 1-2 times before, and never actually saw the basketball court. The gym is still new and shows signs of construction around the locker room and weight rooms. I made my way to the locker room and took out my Nike Hyperdunks from my Nike duffel bag which I’ve done hundreds of times. I also took out a compression sleeve I had received a few years back when I had a minor strain to my MCL.

When my Hyperdunks hit the locker room floor, something clicked in my brain. It was a strange sensation, almost like deja vu. This was an act I’ve done time and time again, stopped doing for 9 months, and picked it up again after the break. It feels like seeing your high school friend, no matter how many years have passed, you still feel a sense of familiarity and closeness regardless of time passed.

Akin to a soldier putting on his gear to go into battle, I too felt like I was finally getting a shot at some action. I loosely tied my shoes, locked my duffel bag, and made my way up to the court.

There was already a 5-on-5 game going on and I saw a few people shooting around on one side of the court. An all too familiar feeling. I casually walked up to the guys shooting around and asked if they had next. They said they had 4 guys and I would be the 5th, so I came just in time. I walked over to the sideline and did my normal routine of dynamic stretching and got my legs warm.

I’ve written about my routine before, and the routine of playing a pickup basketball game is no different. The current game finally ends and there’s always a downtime of 5-10 minutes when the winning team takes a break to recover. Our team is waiting to play but no one’s ready and no one wants to be “that guy” who rushes everyone to get back on the court, so I just shoot around some more and get my body ready for what I hope to be a “light” game.

I end up guarding the best guy on the other team who is checking the ball, and in my mind I’m already saying “oh boy, here we go.” We’re at the top of the key and the guy checks me the ball. In this moment of getting passed the ball, I feel a smile come across my face. It was a smile I couldn’t hide because of all the giddiness and excitement I was feeling from actually getting to play again with guys who were semi-decent.

Over the last 9 months, this feeling made up for all the pain the few days following surgery, the helplessness during the first two weeks when my dad and friends helped me with the basics of life, and the rote stretching and strengthening every Sunday morning in my building’s small gym.

If I could bottle up that feeling of checking the ball and getting into a defensive stance, I would take that bottle and chug it every single day to re-live that euphoric experience. Perhaps it shows the influence basketball has on my life, or the satisfaction coming from working towards a goal, I knew that this would be a defining moment in my recovery process.

From that point on, the instincts and training took over. As I ran up and down the court on offense, started shuffling on defense, and jumped with 50% to grab rebounds, an internal voice told me to not give 100% and still guard against injury. I knew it wasn’t worth re-injuring something or trying to get back to the level I was before. I still remember a few moves that as I was doing them, I affirmed to myself that I could still do certain things and “this felt like the old me.”

For instance, I caught the ball in the high post on one play, turned around to the defender and did a quick pump fake to get him in the air, and then dribbled into the lane for a light jump hook. On another play, I went around a screen on the baseline going towards the sideline, caught a pass, and hit a medium-range jumper. As I ran towards the screen and flared out, I remember feeling all the training of pivoting and change of direction coming to the surface, like this was the exact move I was supposed to do at this point in the game. After I sank the shot, a few of my teammates mumbled “nice shot” even though it was just a medium-range jumper on the baseline. That feeling of doing something good, and being recognized for it, is one of the reasons that keeps me going back to this game even though the play was short of extraordinary.

I lost all 3 games I played, but didn’t care since I was able to play full court and was actually contributing on both offense and defense. I remember one play I got a little ambitious, and actually had the ball on a fastbreak with only one defender in view. I passed half court dribbling as fast as I could, and knew the defender had good handles since he was the other team’s point guard. He cleanly swiped the ball from me and I broke my fall as best as I could careful not to injure anything, and as I got up told myself internally that was not the best idea (but I had to give it a shot any way).

Afterwards, we were all hanging out on the bleachers and I noticed a light scar on the knee of the guy who I was guarding. He was a black guy, about 5’11”, and similar build as me. I asked him if he had surgery and he said he had broke his knee back in high school hence the scar. I showed him my relatively fresh scar, and we both commiserated about the recovery process despite my injury happening a decade or so after his. For those who have gone through knee surgery recovery, that experience is fresh in your memory and gives you a perspective on conditioning, sports, and life that only others like you will understand.

The gym closed soon after our last game, and I headed back down to the locker room to pack my stuff. I left the court feeling high on adrenaline, and wish I could’ve played a few more games with these guys since it wasn’t a super serious game but still competitive enough for people to care. The next morning, the reality of what I’ve done set in.

A Hopefully Minor Setback

Long story short, I went a little too hard during pickup, and my knee swelled up a bit so I did the normal REST routine plus some NSAIDs. In all my years playing basketball, I’ve never had my knees swell up before after playing, but I’ve come to terms with the reality that this is my condition and will most likely happen in future games where I play too hard on my knee.

I went on vacation for a week and after coming back, swelling went down and I was ready to get back into strengthening and playing again. The problem was, I couldn’t run on the treadmill past 6.5mph without feeling some pain on my patella. I would try to warm up and stretch as much as I could, but once I started running/jogging at 8.0mph, the discomfort would set in and I didn’t feel like my knee was strong enough to maintain the fast speed.

After seeing my physio last week, the diagnosis is that I may have some light patella tendonitis or patellofemoral pain which is associated with over use of the knee joint. Apparently all ACL recovery patients who have used a patella autograft will go through this type of pain or discomfort at some point during their recovery, but it usually happens earlier in the recovery process, not this late in the game. I’ve never really had any issues with patella tendonitis so my physio said this may just be the syndrome catching up with me after I played those few games of basketball. Additionally, my Biodex measurement went to a 30% deficiency on my injured leg in terms of endurance or “slow” strength on my quad. My deficiency up until that measurement was only in the 10%-15% range.

The prescription, for now, is no agility or jumping, and no running at fast speeds for a week or so for the flare up to calm down. My routine is back to good ol’ strengthening doing squats, deadlifts, and other closed-chain exercises. I’m doing the elliptical now for cardio to avoid flaring up the patella on the treadmill.

Was it all worth it? Were those few pickup games worth the condition my knee is in right now? Absolutely. As irrational as it sounds, recreational athletes beat themselves up, recover, and get back into their sport to have the process start all over again. This constant performing and rebuilding cycle is what keeps you healthy and active to a certain extent, although my performance over time will continue to decrease with age. I’m getting a little poetic now, but I can’t help thinking about the work going into the last 9 months and the goal I’ve set for myself which is getting back to playing in various leagues and pickup ball.

 

New Non-Invasive ACL Surgery?

Tried my best to get through a detailed post from b-reddy about a new form of non-invasive surgery championed by Dr. Martha Murray:

Detail of the actual operation from b-reddy’s YouTube channel:

I posted a comment on b-reddy’s post about this new surgery, and I tend to agree with his point that this surgery is still way too new, but maybe that’s how all revolutionary movements start? The gold standard has always been a patella autograft, and those who are going to undergo ACL reconstruction or have had ACL reconstruction may harbor confirmation bias towards this operation over inferior operations (i.e. allograft). In other words, the sample set is not big enough for this new form of surgery and thus I would not elect to get this operation if I tore my ACL today and needed to select my preferred ACL reconstruction operation.